The latest numbers from the U.S. Census show that 187,000 Connecticut residents, or one in twenty of us, were uninsured last year. That’s both good and bad news. In 2009, before the Affordable Care Act as we entered a long recession, 305,000 state residents had no health coverage. That’s real progress; let’s rest there a bit.
It means that since 2009, 118,000 fewer Connecticut residents risk financial ruin if they or a loved one gets seriously ill or injured.
But too many of us still carry that worry. Connecticut’s uninsured rate appears to have stabilized at around 5% over the last few years. While our rate is lower than the U.S., six other states and the District of Columbia are doing better than us. For example, in Massachusetts, another expensive state, only 2.8% of residents, are without coverage and their rate continues to fall.
Given Connecticut’s decision to expand Medicaid for very low-income adults and the Affordable Care Act’s (ACA) health insurance subsidies for people a bit above those income limits, why isn’t everyone covered?
Of course, the answers are diverse and complicated, because this is healthcare.
Most uninsured can’t afford coverage. Let’s just deal with the lingering myth that the uninsured can afford insurance but they would just rather take their chances. The insurance industry calls them “free riders” implying that they are choosing to let the rest of us pay the bills for them if something terrible happens. But nothing could be farther from the truth. Only 2% of uninsured Americans report that they don’t believe they need health coverage. For almost half the cost is too high and the other half either lost coverage or their employer doesn’t offer it.
Health insurance is expensive, especially in Connecticut. At $20,735 for family coverage last year, health coverage consumed 28% of the median Connecticut household income. That means half of Connecticut families would pay more than 28% forcing sacrifices in other areas like housing, transportation, and saving for the future. Only half of Connecticut firms offer health benefits to workers, and part-time employees are six times less likely to get health insurance through work. Small businesses and their workers are hit even harder.
The ACA’s federal subsidies help but costs are still out of reach for many working Connecticut families. Most uninsured Connecticut families have incomes between $25,000 and $50,000, too much for meaningful subsidies but too little to afford premiums.
Others who choose not to buy insurance are wondering if coverage is worth the price. Connecticut deductibles have more than doubled over the last ten years, now the third highest in the nation for single plans. Two thirds of single coverage and over half of family coverage in Connecticut is now through a high-deductible plan and only half of Connecticut employers contribute anything toward those costs through the associated savings accounts.
Consequently many in our state are paying for most or all of their healthcare out-of-pocket while still paying premiums every month for insurance they never use. Add to that confusing rules about what is covered, what care will cost, which drugs are covered at what price, who is in the network, and the substantial surprise bills that come months later for unknowingly going outside that network.
The healthcare market has failed. And our high prices are not reflected in the quality of care we’re getting. Unless they have assets to protect, it’s understandable if some Connecticut residents are starting to doubt the value of health insurance.
Another big contributor to the number of uninsured are the estimated 120,000 Connecticut residents are undocumented immigrants who don’t qualify for Medicaid and can’t purchase coverage through AccessHealthCT, Connecticut’s health insurance exchange, even at full price. Non-citizens are over eight-fold more likely to be uninsured in our state.
What can we do about it? Prices for healthcare are just too high. Real action is needed at the national level. While tweaks like a public option or allowing some to buy into Medicare will help a few, the big problem will continue. Other countries have better systems, there are plenty of models to choose from.
While Washington languishes in partisan gridlock, state policymakers are looking for solutions. Laws to limit deductibles, surprise bills, and other out-of-pocket costs are well-intentioned but will only cause premiums to rise faster because healthcare is a classic whack-a-mole game. State public option proposals to shift people between insurance pools might help around the margins, but until we address input costs, healthcare spending is not going to come down. Connecticut could take action to reduce drug costs, the main driver of rising healthcare costs, but it’s been hard to get passed. We could improve public health spending to keep everyone healthy and lower input costs. Regulating large health systems that are limiting competition would help bring costs down. There is no lack of ideas.
The Affordable Care Act, coming up on its 10th anniversary, was a great start. But the work continues, both in Washington and in Hartford. Try all these ideas and everyone else’s too, but be ruthless in evaluation and shutting down failed experiments. The rule of unintended consequences is very strong – managed care reform in the 1990s did nothing to manage care. We don’t have time or money to waste on ideas that don’t work.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
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